Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Int J Hematol. 2012 Nov;96(5):562-71. doi: 10.1007/s12185-012-1189-4. Epub 2012 Oct 17.
Recently reported results of well-designed prospective clinical trials for extranodal NK/T-cell lymphoma, nasal type (ENKL) have rapidly changed the management of ENKL. This review will focus on the evidence obtained from prospective clinical trials for ENKL and discuss the most highly recommended current management and future directions for the better management of ENKL. For patients with nasal NK/T-cell lymphoma of stage IE or contiguous stage IIE with cervical node involvement, concurrent chemoradiotherapy with radiotherapy (RT) and a two-thirds dose of DeVIC chemotherapy is recommended as a first-line treatment. To obtain the expected clinical outcome, performing RT following the same procedure as that reported is important. For the other patients with newly diagnosed ENKL, SMILE chemotherapy is recommended as an induction therapy. The Epstein-Barr virus DNA load in peripheral blood is useful for both prognostication and monitoring during the follow-up after treatment. Other L-asparaginase-containing chemotherapies and chemotherapies containing non-multidrug resistance-related agents and etoposide are good options for elderly patients or patients with impaired organ function. As in the cases of other aggressive lymphomas, prospective clinical trials with adequate statistical considerations should be conducted to improve the prognosis of patients with ENKL.
最近报道的设计良好的前瞻性临床试验结果迅速改变了结外 NK/T 细胞淋巴瘤，鼻型（ENKL）的治疗方法。本综述将重点介绍来自前瞻性临床试验的证据，并讨论当前最推荐的 ENKL 管理方法和未来方向，以更好地管理 ENKL。对于 I 期 E 或连续 IIE 期且有颈部淋巴结受累的鼻腔 NK/T 细胞淋巴瘤患者，推荐采用放化疗联合治疗，放疗（RT）和 DeVIC 化疗的 2/3 剂量作为一线治疗。为了获得预期的临床效果，按照报道的相同程序进行 RT 很重要。对于其他新诊断的 ENKL 患者，建议采用 SMILE 化疗作为诱导治疗。外周血中 EBV DNA 载量对于治疗后随访期间的预后和监测都很有用。其他含有 L-天冬酰胺酶的化疗药物和含有非多药耐药相关药物和依托泊苷的化疗药物是老年患者或器官功能受损患者的良好选择。与其他侵袭性淋巴瘤一样，应该进行充分考虑统计学因素的前瞻性临床试验，以改善 ENKL 患者的预后。
